Patch test reactions in atopic patients

Patch testing was carried out in 851 atopic patients; 181 atopic dermatitis (AD) patients were additionally tested with 50% dilutions of the test substances. The occurrence of allergic and irritant reactions was frequent, being 57% and 33% for AD patients aged 28-41 years and 19-27 years, respectively. Among age-matched allergic rhinitis (AR)/allergic conjunctivitis (AC) or asthma (A) patients, the number of allergic reactions varied from 25 to 30%, and for irritant reactions was 24%. In all groups, nickel, fragrance-mix, balsam of Peru and neomycin were the commonest allergens. Contact allergy to ingredients of topical medicaments was common among AD patients and patients with severe and long-lasting dermatitis were most frequently sensitized. However, sensitivity to multiple substances was not common among those patients. The number of irritant reactions was considerable, but 50% dilution of the test substances did not solve the problem.     

等比分配二次混合的方法研究

目的:建立等比分配二次混合方法,并使此类混合合理化。方法:提出等比分配二次混合方法的基本构架,借助数学工具,运用推理和实验验证的方法进行方法研究。结果:建立了等比分配二次混合方法,实验证明此方法可行。结论:等比分配二次混合法是一个可用于工业化生产,既科学合理又经济可行的特殊混合方法。     

The association of Hospital Medicare beneficiary payer-mix,national quality rankings and outcomes following hepatopancreatic surgery

IntroductionWe sought to determine the impact of payer-mix on post-operative outcomes among Medicare beneficiaries following hepatopancreatic surgery.MethodsMedicare beneficiaries who underwent hepatopancreatic surgery were identified. Hospital quality markers were obtained from the Hospital General Information dataset. Hospitals were dichotomized (low/average vs. high) based on Medicare patient days versus all patient days irrespective of payer type.ResultsHigh Medicare patient-mix hospitals were more likely to be ranked higher than the national average relative to safety of care (29.4% vs. 38.1%) and timeliness of care (15.4% vs. 26.3%) versus low burden Medicare hospitals (both p < 0.001). However, Medicare beneficiaries who had hepatopancreatic surgery at a high Medicare patient-mix hospital were at higher risk of a complication (OR = 1.13, 95%CI 1.04–1.22), and death within 30-days (OR = 1.37, 95%CI 1.23–1.53) following surgery.ConclusionWhile hospitals caring for higher numbers of Medicare beneficiaries generally performed better on CMS quality indicators, these rankings did not equate to improved post-operative outcomes.     

A healthcare staff decision model considering the effects of staff cross‐training

In this study a staff planning model for a health service clinic has been developed and validated using an example case of a health service clinic. The primary purpose of this research is to develop a representative staff planning model which balances the cost and benefits of staff task flexibility through crosstraining for a healthcare facility. Additionally, legal requirements for task substitution in the healthcare industry have been considered in the model.     

Conceptualizing the impacts of dual practice on the retention of public sector specialists - evidence from South Africa

Background

‘Dual practice’, or multiple job holding, generally involves public sector-based health workers taking additional work in the private sector. This form of the practice is purported to help retain public health care workers in low and middle-income countries’ public sectors through additional wage incentives. There has been little conceptual or empirical development of the relationship between dual practice and retention.

Methods

This article helps begin to fill this gap, drawing on empirical evidence from a qualitative study focusing on South African specialists. Fifty-one repeat, in-depth interviews were carried out with 28 doctors (predominantly specialists) with more than one job, in one public and one private urban hospital.

Results

Findings suggest dual practice can impact both positively and negatively on specialists’ intention to stay in the public sector. This is through multiple conceptual channels including those previously identified in the literature such as dual practice acting as a ‘stepping stone’ to private practice by reducing migration costs. Dual practice can also lead specialists to re-evaluate how they compare public and private jobs, and to overworking which can expedite decisions on whether to stay in the public sector or leave. Numerous respondents undertook dual practice without official permission.

Conclusions

The idea that dual practice helps retain public specialists in South Africa may be overstated. Yet banning the practice may be ineffective, given many undertake it without permission in any case. Regulation should be better enforced to ensure dual practice is not abused. The conceptual framework developed in this article could form a basis for further qualitative and quantitative inquiry.

Electronic supplementary material

The online version of this article (doi:10.1186/1478-4491-13-3) contains supplementary material, which is available to authorized users.     

Modern epidemiology of hepatitis A in the north-western region of the Russian Federation

Summary.  The epidemiological features of hepatitis A virus (HAV) infection were studied in eleven territories located in the north-western region of the Russian Federation. The dynamics of HAV infection in Russia and in the region were evaluated during a 17-year period. The age-specific incidence was calculated and 229 305 patients with acute HAV were identified. The analysed database included HA mixed with other viral hepatitis infections: it included information about 8 809 HAV patients. Special attention has been paid to the sero-epidemiological studies conducted in St Petersburg city. These studies included analysis of age-specific incidence in persons 20 years of age and older during 6 years and testing of blood sera from 1 892 healthy persons for IgG anti-HAV. In general there is a trend to reduction of HAV incidence in Russia, and in the north-western region, high indices were registered in some provinces in different years. It was established three types of age-specific incidence distribution: predominated incidence in 3–14 years of age (first type), 15–29 years of age (second type) and uniform distribution in different age groups (third type). It was shown that decrease of HAV incidence in children and young adults lead to the reduction of sero-positivity level in the groups 20+ years of age. These characteristics should be taken in account to define indications for HAV vaccine prophylaxis. HAV infection in 10–13% of cases mixed with acute or chronic hepatitis B and C in the last 15 years in St Petersburg. In the middle of 1990s, HAV mostly mixed with acute viral hepatitis of different aetiology, but in the modern time predominated type of mixture was presented by HAV and chronic HBV and HCV infections. The obtained results are useful for viral hepatitis surveillance and control.     

Influence of Design Parameters on Fresh Properties of Self-Compacting Concrete with Recycled Aggregate—A Review

This article presents an overview of the bibliographic picture of the design parameter’s influence on the mix proportion of self-compacting concrete with recycled aggregate. Design parameters like water-cement ratio, water to paste ratio, and percentage of superplasticizers are considered in this review. Standardization and recent research on the usage of recycled aggregates in self-compacting concrete (SCC) exploit its significance in the construction sector. The usage of recycled aggregate not only resolves the negative impacts on the environment but also prevents the usage of natural resources. Furthermore, it is necessary to understand the recycled aggregate property’s role in a mixed design and SCC properties. Design parameters are not only influenced by a mix design but also play a key role in SCC’s fresh properties. Hence, in this overview, properties of SCC ingredients, calculation of design parameters in mix design, the effect of design parameters on fresh concrete properties, and the evolution of fresh concrete properties are studied.     

Evaluating quality in clinical care

Defining and maintaining quality is essential to surgical practice. It is only through structured approaches to assessing outcomes that we can ensure that optimal care is delivered. This article will define quality in healthcare and discuss assessment models with reference to pertinent surgical literature. National initiatives are discussed with a critical appraisal of their role and effectiveness. We discuss the aim of quality improvement initiatives and comment on reporting of outcomes. The difficult question of how to maintain quality during a crisis, such as an infectious disease pandemic, is addressed.